NOTICE OF PRIVACY PRACTICES
Effective: July 1, 2009
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At CeltiCare your privacy is important to us. We will do all we can to protect your health records. By law, we must protect your health records and send you this notice.
This notice tells you how we use your health records. It describes when we can share your records with others. It explains your rights about the use of your health records. It also tells you how to exercise those rights and who can see your health records. This notice does not apply to information that does not identify you.
When we talk about your health records in this notice, it includes any information about all of your health services while you are a member of CeltiCare. This includes providing healthcare to you and also includes payment for your healthcare while you are our member.
Please note: Commonwealth Care and Choice members will also receive a Privacy Notice from the Commonwealth Health Insurance ConnectorAuthority outlining their rules for your health records. Other health plans and healthcare providers may have other rules when using or sharing your health records. We ask that you obtain a copy of their Privacy Notices and read them carefully.
How We Use or Share Your Health Records.
Here are ways we may use or share your health records:
- To help pay your medical bills given to us by healthcare providers.
- To help your healthcare providers give you the proper care. For example, if you are in the hospital, we may give them your records sent to us by your doctor.
- To help manage your healthcare. For example, we might talk to your doctor about a disease or wellness program that could help improve your health.
- To help resolve any appeals or grievances filed by you or a healthcare provider with CeltiCare or the Commonwealth of Massachusetts.
- To assist others who help us provide your health services. We will not share your records with these outside groups unless they agree to protect your records.
- For public health or disaster relief efforts.
- To remind you if you have a doctor’s visit coming up.
- To give you information about other healthcare treatments and programs, such as how to stop smoking or lose weight.
State and federal laws may call for us to give your health records to others for the following reasons:
- To state and federal agencies that oversee us, such as the Commonwealth Health Insurance Connector or United States Department of Health and Human Services.
- For public health actions. For example, the Food and Drug Administration may need to check or track medicines and medical device problems.
- To public health groups if we believe there is a serious public health or safety threat.
- To a health agency for certain activities. This might include audits, inspections, and licensure or enforcement actions.
- To a court or administrative agency.
- To law enforcement. For example, records may be used to identify or find someone who is a suspect, fugitive, material witness or missing person.
- To a government person about child abuse, neglect or violence in your home.
- To a coroner or medical examiner to identify a dead person or help find a cause of death. These may be needed by a funeral director to help them carry out their duties.
- For organ transplant purposes. For special government roles, such as military and veteran activities, national security and intelligence activities, and to help protect the President and others.
- For job-related injuries due to your state’s worker compensation laws.
- If one of the above reasons does not apply, we must obtain your written approval to use or share your health records with others. If you change your mind, you may retract your written approval at any time.
- If sharing your health information is not allowed by or limited by a state law, we will obey the law that protects your health information best.
What Are Your Rights?
The following are your rights with regards to your health records. If you would like to exercise any of the following rights, please contact us. We can be reached at (866) 895-1786.
- You have the right to ask us to give your records only to certain people or groups and to say for what reasons. You also have the right to ask us to stop your records from being given to family members or others who are involved in your healthcare. Please note that while we will try to follow your wishes, the law does not make us do so.
- You have the right to ask to get confidential communications of your health records. For example, if you believe that you would be harmed if we send your records to your current mailing address, you can ask us to send your health records by other means. Other means might be fax or an alternate address.
- You have a right to request mental health records. This information can only be provided with the approval of the treating provider responsible for the condition to which the information relates, or another equally qualified mental health professional. Upon release of any medical or mental health record information to a medical professional designated by you, CeltiCare will notify you that the information was provided to the medical professional.
- You have the right to view and get a copy of all the records we keep about you in your designated record set. This consists of anything we use to make decisions about your health. It includes enrollment, payment, claims processing and medical management records.
You do not have the right to get certain types of health records. We may decide not to give you the following:
- Information contained in psychotherapy notes.
- Information collected in reasonable anticipation of, or for use in a court case or another legal proceeding.
- Information subject to certain federal laws about biological products and clinical laboratories.
- In certain situations, we may not let you get a copy of your health records. You will be informed in writing. You may have the right to have our action reviewed.
- You have the right to ask us to make changes to wrong or incomplete health records we keep about you. These changes are known as amendments. Any request for an amendment must be in writing. You need to give a reason for your change(s). We will get back to you in writing no later than 30 days after we receive your request. If your health information is not maintained on-site, we will respond no later than 60 days after we receive your request. If we need additional time, we may take up to another 30 days. We will inform you of any delays and the date when we will get back to you.
- If we make your changes, we will let you know they were made. We will also give your changes to others who we know have your health records and to other persons you name. If we choose not to make your changes, we will let you know why in writing. You will have a right to submit a letter disagreeing with us. We have a right to answer your letter. You then have the right to ask that your original request for changes, our denial and your second letter disagreeing with us be put with your health records for future disclosures
- You have the right to receive an accounting of disclosures of your health records to others for six years beginning on the first day or enrollment with CeltiCare. By law, we do not have to give you a list of the following:
- Health records given or used for treatment, payment and healthcare operations purposes.
- Health records given to you or others with your written approval.
- Information that is incidental to a use or disclosure otherwise permitted.
- Health records given to persons involved in your care or for other notification purposes.
- Health records used for national security or intelligence purposes.
- Health records given to prisons, police, FBI and others who enforce laws or health oversight agencies.
- Health records given or used as part of a limited data set for research, public health or healthcare operations purposes.
To receive an accounting of disclosures, your request must be in writing. We will act on your request within 60 days. If we need more time, we may take up to another 30 days. Your first list will be free. We will give you one free list every 12 months. If you ask for another list within 12 months, we may charge you a fee. We will tell you the fee in advance and give you a chance to take back your request.
Using Your Rights:
- You have a right to receive a copy of this notice at any time. We reserve the right to change the terms of this notice. Any changes in our privacy practices will apply to all the health records that we keep. If we make changes, we will send a new notice to you.
- If you have any questions about this notice or how we use or share your health records, please call. We can be reached at (866) 895-1786, Monday through Friday from 8:00 a.m. to 5:00 p.m.
If you believe your privacy rights have been violated, you may write a letter of
CeltiCare Health Plan of Massachusetts, Inc.
Brighton, Massachusetts 02135
Phone: (866) 895-1786
Fax: (888) 828-5698
You may also contact the Secretary of the United States Department of Health and Human Services
Office for Civil Rights – Region I
U.S. Department of Health & Human Services
Boston, MA 02203
Voice phone (617) 565-1340
Fax: (617) 565-3809
TDD (617) 565-1343
WE WILL NOT TAKE ANY ACTION AGAINST YOU FOR FILING A COMPLAINT.